Medication for Alcoholism: Types, Side Effects, and Management

What Is Alcoholism?

Alcoholism, also known as alcohol use disorder (AUD), is a chronic condition characterized by an inability to control or stop drinking despite negative consequences.¹ Unlike many other addictions, AUD is treated differently due to its complex nature and often involves a combination of medications, counseling, and support groups to overcome.

Alcoholism can have severe and damaging effects on families and relationships, often causing breakdowns in communication and leading to interpersonal conflicts. It can also disrupt everyday life, such as work and school, impairing someone’s physical health or even leading to long-term liver disease, cardiovascular problems, and mental health issues. Diagnosis of alcoholism is typically done using the DSM-5 criteria (Diagnostic and Statistical Manual of Mental Disorders).²

The prevalence of alcoholism is a significant public health concern. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), in the 2021 National Survey on Drug Use and Health, 28.6 million adults ages 18 and older (11.3% in this age group) had AUD in 2021. It is more prevalent in males than females, and certain populations, such as Native Americans, tend to have higher rates of AUD. Recognizing the impact of alcoholism and seeking appropriate treatment and support is crucial in addressing this widespread issue.³

Common symptoms of an AUD include:⁴

• Binge drinking, often more or longer than intended.
• Experiencing alcohol withdrawal symptoms when not drinking.
• Craving or a strong desire to consume alcohol.
• Difficulty controlling or limiting the amount of alcohol consumed.
• Continual use of alcohol despite persistent physical or psychological problems caused by drinking.
• Developing a tolerance to alcohol, requiring more significant amounts to achieve the desired effect.
• Experiencing withdrawal symptoms, such as tremors, nausea, sweating, or anxiety, when attempting to stop or cut back on drinking.
• Spending a significant amount of time obtaining alcohol, drinking, or recovering from its effects.
• Neglecting or reducing important social, occupational, or recreational activities due to alcohol use.
• Persisting with alcohol use despite being aware of its detrimental effects on relationships, family, or personal well-being.
• Making unsuccessful efforts to quit or cut down on alcohol consumption.

*The presence of at least two of these symptoms within a 12-month period is typically required for an AUD diagnosis.

6 Medications to Treat Alcoholism

These medications for alcohol use disorder (AUD) are typically used as part of a comprehensive treatment approach that includes therapy and support. While medications like naltrexone, acamprosate, and disulfiram can be valuable in reducing withdrawal symptoms and cravings, they are not standalone solutions. AUD often involves complex behavioral and psychological factors, such as underlying trauma or co-occurring mental health conditions, which require comprehensive treatment and behavioral interventions.

1. Naltrexone (Revia)

Naltrexone, commonly prescribed under the brand name Revia, is a medication used to treat alcohol use disorder (AUD). Naltrexone is the medication used with the Sinclair Method. It works by blocking the opioid receptors in the brain, which reduces the pleasurable effects of alcohol and helps to decrease alcohol cravings. Naltrexone can be taken in two different forms: as a daily oral tablet or as a monthly extended-release injection called Vivitrol.

Studies have shown that naltrexone can be effective in reducing drinking days, heavy drinking episodes, and relapse rates among individuals with AUD. However, it is important to note that naltrexone is not a standalone solution and should be used in conjunction with counseling and behavioral therapies for optimal results.¹ Additionally, naltrexone should not be taken by individuals who are currently using opioids or experiencing acute opioid withdrawal symptoms.

Possible side effects of Naltrexone (Reviva) include:

• Risk of death with opioids
• Liver complications
• Nausea
• Headache
• Fatigue
• Dizziness
• Insomnia
• Abdominal pain or cramps
• Joint or muscle pain
• Decreased appetite
• Anxiety or nervousness
• Skin rash or itching

2. Disulfiram (Antabuse)

Disulfiram (Antabuse) is a medication used in the treatment of alcohol use disorder (AUD) that works by creating unpleasant physical reactions when alcohol is consumed. It inhibits the enzyme that breaks down alcohol in the body, resulting in a buildup of a toxic substance called acetaldehyde. This accumulation leads to symptoms such as nausea, vomiting, flushing, rapid heartbeat, and headache. The unpleasant effects of disulfiram serve as a deterrent to drinking alcohol.¹

The effectiveness of disulfiram in reducing drinking has been shown in various studies when taken as a tablet once daily. By creating an aversive reaction to alcohol, disulfiram can help individuals with AUD maintain abstinence. Concerns about the use of disulfiram include potential side effects and the need for caution when using products containing alcohol.¹

Possible side effects of Disulfiram (Antabuse) include:¹

• Vomiting
• Headaches
• Drowsiness
• Fatigue
• Metallic or garlic-like taste in the mouth
• Skin rash or itching
• Acne
• Impotence or sexual dysfunction
• Weakness
• Nervousness or anxiety
• Rarely, severe reactions if alcohol is consumed, such as increased heart rate, difficulty breathing, chest pain, or even cardiovascular events.

3. Naltrexone Injection (Vivitrol)

Naltrexone, in the form of Vivitrol, is an extended-release injection used in the treatment of alcohol use disorder (AUD). It works by blocking the opioid receptors in the brain, reducing the pleasurable effects of alcohol, and curbing cravings. Vivitrol is administered once a month by a healthcare professional, providing a sustained release of naltrexone over the course of the month.¹

To take Vivitrol, an individual must first complete a detoxification period and be free of opioids for at least 7-10 days. Once eligible, a healthcare professional will administer the injection in the buttocks or upper arm. Vivitrol has been shown to be effective in reducing heavy drinking days and promoting abstinence from alcohol. It offers the advantage of sustained release, eliminating the need for daily medication adherence.⁴

Possible side effects of Naltrexone (Vivitrol) include:⁴

• Muscle cramps
• Decreased appetite
• Injection site reactions, such as pain, redness, or swelling
• Nausea or upset stomach
• Headache.
• Fatigue or drowsiness
• Joint pain
• Insomnia or difficulty sleeping
• Dizziness
• Anxiety or nervousness
• Allergic reactions, although rare, may occur

*It is crucial to inform the healthcare provider of any existing medical conditions or medications being taken to ensure the safe and effective use of Naltrexone (Vivitrol).

4. Acamprosate (Campral)

Acamprosate, commonly known as Campral, is a medication used in the treatment of alcohol use disorder (AUD). It works by restoring the balance of certain chemicals in the brain that are disrupted by chronic alcohol use. Acamprosate is thought to reduce cravings and help individuals with AUD maintain abstinence from alcohol.¹

Studies have shown that acamprosate can be effective in reducing alcohol consumption and promoting abstinence. It is especially beneficial for individuals who have already stopped drinking and are seeking support to maintain sobriety. The recommended dosage is usually 666 mg (two tablets), taken three times a day.¹

Possible side effects of Acamprosate (Campral) include:⁴

• Heart problems
• Kidney complications.
• Diarrhea
• Upset stomach
• Nausea
• Changes in appetite
• Dizziness
• Headache
• Sleep disturbances (insomnia or vivid dreams)
• Weakness or fatigue
• Anxiety or nervousness
• Itching or rash

5. Topiramate (Trokendi XR, Qudexy XR, Topamax)

Topiramate is a medication that is sometimes used off-label in the treatment of alcohol use disorder (AUD). While the exact mechanism of action is not fully understood, topiramate is believed to affect various neurotransmitters in the brain, reducing cravings for alcohol and potentially helping individuals with AUD reduce their alcohol intake.¹

Topiramate is taken orally in the form of tablets. The dosage and titration schedule may vary depending on the individual and their specific needs. It is typically started at a low dose and gradually increased to a therapeutic level. Despite research suggesting its use, it is important to note that the use of topiramate for AUD is off-label, meaning it is not specifically approved by regulatory authorities for this purpose.¹

Possible side effects of Topiramate include:⁴

• Respiratory problems
• Dizziness or lightheadedness
• Fatigue or tiredness
• Confusion or difficulty concentrating
• Nervousness or anxiety
• Tingling or numbness in the extremities
• Changes in taste sensation
• Loss of appetite or weight loss
• Nausea or upset stomach
• Diarrhea
• Blurred vision or other visual disturbances

6. Gabapentin (Neurontin)

Gabapentin is a medication that is sometimes used off-label in the treatment of alcohol use disorder (AUD). While its exact mechanism of action is not fully understood, gabapentin is believed to affect certain neurotransmitters in the brain, reducing excitability and calming overactive neural activity. This can help alleviate cravings and potentially assist individuals with AUD in reducing their alcohol consumption.⁴

Gabapentin is typically taken orally in the form of capsules or tablets. The dosage and treatment plan may vary depending on the individual’s specific needs and response to the medication. Research suggests that gabapentin may be effective in reducing alcohol cravings, promoting abstinence, and improving overall treatment outcomes in individuals with AUD. However, it is important to note that the use of gabapentin for AUD is off-label, meaning it is not specifically approved by regulatory authorities for this purpose.⁴

Possible side effects of Gabapentin include:⁴

• Drowsiness or sedation
• Dizziness or lightheadedness
• Fatigue or tiredness
• Coordination difficulties or unsteadiness
• Nausea or upset stomach
• Dry mouth
• Blurred vision
• Weight gain
• Mood changes or irritability
• Memory problems or difficulty concentrating

How to Choose the Best Alcoholism Medication for You

After being diagnosed with AUD or alcoholism, patients should consult with their provider to determine if medication is an appropriate treatment option in addition to alternative therapies. Every individual is unique, and the decision to prescribe depends on various factors, including the severity of AUD, the presence of additional conditions, and overall health.

It is crucial to have open and honest discussions with the healthcare provider and provide comprehensive information about past alcohol use patterns, previous treatment attempts, and any known sensitivities or allergies to medications.

Medications such as the ones discussed previously may be prescribed based on individual needs. Many of these medications cannot be taken with other medications due to potentially harmful interactions, and that can have an effect on which treatments for AUD are an option for you.

Other Treatment Options for Alcoholism

Alcohol use disorder (AUD) is typically treated using various forms of psychotherapy in both inpatient and outpatient rehab settings. Talk therapy, such as cognitive-behavioral therapy (CBT), motivational interviewing, and family therapy, is commonly employed to address the psychological, emotional, and behavioral aspects of AUD.

These therapies help individuals understand their triggers, develop coping skills, and establish healthier thinking patterns and behavior related to alcohol use.³ It is also important to recognize that everyone will respond differently to treatment, and finding the right approach may take time.

Research has shown that medication can play a valuable role in suppressing symptoms and improving the experiences in talk therapy for individuals with AUD. Medications like naltrexone, acamprosate, disulfiram, and others have been studied extensively, and they have demonstrated efficacy in reducing cravings, managing withdrawal symptoms, and supporting recovery efforts. By alleviating some of the physiological aspects of AUD, medication can enhance the effectiveness of talk therapy and provide a more solid foundation for behavioral changes.⁹

Therapy methods to treat an AUD may include:⁵

• Rehab: Short for rehabilitation, rehab refers to structured programs designed to help individuals overcome substance abuse, including alcohol addiction. Rehab offers a supportive and structured environment where individuals receive professional guidance, evidence-based therapies, and peer support to address the physical, psychological, and social aspects of alcohol use disorder.
• Cognitive Behavioral Therapy (CBT): CBT is a form of psychotherapy that focuses on identifying and changing negative thought patterns and behaviors. CBT is beneficial for reducing alcohol consumption as it helps individuals recognize and challenge their alcohol-related beliefs, develop healthier coping strategies, and address underlying emotional and cognitive factors contributing to their alcohol use.
• Motivational Enhancement Therapy (MET): MET is a therapeutic approach that aims to enhance an individual’s motivation and commitment to change their alcohol consumption. It is beneficial for reducing alcohol consumption as it helps individuals explore and resolve ambivalence about their drinking, increases self-efficacy and intrinsic motivation for change, and supports individuals in setting achievable goals and developing a plan to reduce or quit drinking.
• Group therapy: Group therapy is a form of therapy where individuals with similar challenges, such as alcohol addiction, come together to share experiences, provide support, and receive guidance from a trained therapist.
• Support groups: Support groups are organized gatherings of individuals who share similar experiences or challenges, such as alcohol addiction, and come together to provide mutual support, encouragement,
• 12-Step programs: 12-step programs, such as Alcoholics Anonymous (AA), are structured support programs that follow a set of guiding principles and steps to help individuals overcome alcohol addiction. These programs provide a supportive community, a structured recovery framework, a focus on personal accountability, and spiritual growth, all of which can promote abstinence, sobriety, and a sustained commitment to reducing alcohol use.

In My Experience

In my experience, alcoholism is a complicated chronic issue that requires as much support as possible. It is crucial for anyone undergoing treatment for AUD to understand that they have a support system in addition to any medications they may be taking for the condition.

It takes an often long treatment with support from friends, family, support groups, and their providers to truly overcome it. Even then, there is often the concern for relapse and the dangers of the individual feeling as though they may have lost crucial progress from it.

When it comes to taking any of these medications, the most important advice I can offer is to be honest and candid with your provider about how effectively they are working and not being afraid to try something else in addition to alternative therapies to ensure someone gets the best treatment that fits their personal needs as this is a condition very specialized to each patient.

For Further Reading

• Living With an Alcoholic: 5 Strategies & When to Seek Help
• Alcohol & Anxiety: Connections & Risks
• 15 Best Books on Alcoholism and Recovery
• National Institute on Alcohol Abuse and Alcoholism
• SAMHSA’s National Helpline for Substance Abuse
• How to Stop Alcohol Cravings: NIH
• Alcoholism Resources and Support Groups